Trend has been accelerating, U.S. figures show
THURSDAY, Nov. 15 (HealthDay News) -- Black children with diabetes face a death rate twice as high as that for white children, new U.S. government research shows.
While this racial disparity has been evident for more than two decades, the trend has been accelerating among children ages 1 to 19, according to the study in the Nov. 16 issue of the Morbidity and Mortality Weekly Report, published by the U.S. Centers for Disease Control and Prevention.
"Although the numbers are small, in absolute terms, these deaths are still preventable, which is why it is important to examine those disparities and work toward eliminating them," said CDC epidemiologist Dr. Laura L. Polakowski, who co-authored the report.
Looking at death certificates from 1979 to 2004, the researchers found that between 2003 and 2004, there were 89 deaths among U.S. children and teens from diabetes. During that time, the annual diabetes death rate for black children and teens was more than double that for white children.
From 2003 to 2004, the diabetes death rate per million for children and teens was 2.46 for blacks and 0.91 for whites, the report found.
In addition, the death rate among blacks has been increasing since 1998, while for whites it decreased significantly from 1979 to 1994, and then leveled off from 1994 to 2004, Polakowski's team found.
A complex interplay of factors seems to be driving the disparity, Polakowski said. "Possible explanations could be differences in access to or use of health-care services, or differences in quality of diseases education and care," she said.
Polakowski's group did not distinguish between juvenile diabetes, commonly called type 1 diabetes, and adult onset diabetes, often called type 2 diabetes. However, most diabetes deaths among children are caused by short-term complications from type 1 diabetes, Polakowski said. "We know we see these deaths with type 1 diabetes, we don't know if we see them with type 2 diabetes at this point," she said.
Many of these deaths are due to acute complications such as diabetic ketoacidosis, in which insulin levels are too low. If untreated, it leads to diabetic coma and eventually death, Polakowski said.
"These complications are readily recognizable in children and don't require a great deal of technology to treat them," Polakowski said. "The rate of death among black children can be lower, because there is a lower rate among white children," she said.
Type 1 diabetes is typically diagnosed in children and young adults and results when the body does not produce insulin, a hormone that converts blood sugar to energy for the body's cells. With type 2 diabetes -- the most common form of the disease -- either the body doesn't produce enough insulin or cells ignore the insulin, according to the American Diabetes Association. The obesity epidemic plaguing American children and adults is believed responsible for much of the explosion in type 2 diabetes cases.
One expert agrees that the pediatric deaths detailed in the new CDC report are preventable.
"I am not surprised that there would be a disparity," said Dr. Larry Deeb, past president for medicine and science at the American Diabetes Association. "That just reflects America -- doesn't it?"
All these deaths are from diabetic ketoacidosis, Deeb said. "That's what kills children with diabetes, and most of these deaths are preventable," he said.
Deeb thinks the racial disparity in diabetes deaths among children results from too many black children not having easy access to health care. With improved access and better diabetes education, "we can eliminate the disparity," he said.
For more on diabetes, visit the American Diabetes Association.
SOURCES: Laura L. Polakowski, M.D., epidemiologist, U.S. Centers for Disease Control and Prevention, Atlanta; Larry Deeb, M,D., past president for medicine and science, American Diabetes Association, Alexandria, Va.; Nov. 16, 2007, Morbidity and Mortality Weekly Report, U.S. Centers for Disease Control and Prevention
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